hank you for asking us to assist you in reviewing your options, including possible bankruptcy. The following questions will assist us in giving you advice such as whether bankruptcy is appropriate, the best time for filing and what danger points you need to be aware of. Please understand that just because you fill out this information you have not committed to filing a bankruptcy. Nor, have we committed to representing you in a bankruptcy. Once we receive your form we will all public records which will help us to guide you through the very complicated bankruptcy process.
Once you have completed the video (step one) and questionnaire (step two) please send it to JAY@DIANEDRAIN.COM or fax it to 602-249-1969. If you fax the form please use black pen or type (blue ink or pencil are rarely legible on a fax copy). We know that you are anxious to talk to Ms. Drain, therefore we ask that you be thorough in finishing this form. Jay will review it, if it is complete he will give it to Ms. Drain who will call to schedule your 30 minutes free telephonic appointment. Do not send this form to Ms. Drain - she receives between 200-400 spams per day and your form may end up in her spam box. Again, please send it to Jay at Jay@DianeDrain.com.
During the free telephonic discussion Ms. Drain will review each page of this questionnaire, ask you questions and answer your questions. Consider writing your questions down beforehand so that you are prepared for the phone conference. At the end of this free telephonic discussion Ms. Drain will be able to quote a fee for her services. But that quote is limited to the circumstances you disclose and only for 3 months following the telephonic discussion. No further services will be rendered by our office, unless you request them and sign a retainer agreement.
Our job is to help you understand the bankruptcy laws and prepare for the process. In doing so we help relieve you deal with issues related to company debts by way of a liquidation of the company. It is important that you inform us of any debts that you have personally guaranteed. Normally those debts will still remain your obligation after your company has filed for a chapter 7 liquidation.
For some it is necessary that I remind you about following directions. For most of you this is not necessary - to you I apologize for the following: 1) Please do not send this form until you have completed step one (watched the educational videos). 2) It is very important that every question on this form be answered and that you sign the three documents attached. If the form is not 100% complete (including the signatures) then Jay will contact you. He will then file your form away until he receives a completed form. 3) Do not forget to complete the means test accurately.
GENERAL INFORMATION
__ Yes ___No I certify that I watched the educational videos about the bankruptcy process. (If you have not, then please so before sending this form to our office.) __ Yes ___No Has your company ever filed bankruptcy before? If yes, list year, state and case number. _____________ (This includes any case which may have been filed, but not completed.) __ Yes ___No Does your company own any property that has been part of a bankruptcy in the last 2 years? __ Yes ___No Has your company ever filed bankruptcy before? If yes, list year, state and case number. _____________ __ Yes ___No Are you going to need to file for bankruptcy also? If so, explain _____________ ________________________________________________________________________
How did you find out about our services?
__________________________________
What do you expect bankruptcy to do for your company:
_________________________________________________________________________
PLEASE ANSWER THE FOLLOWING QUESTIONS:
__
Yes ___No Is there a foreclosure or trustee's sale
pending? The following are general questions to determine the current situation. __ Yes __ No Is there an emergency requiring immediate filing?
If so, why?
___________________________________________________ If so, please explain: _____________________________________________________ __ Yes
___No Have any of the company's assets been seized (eg
garnishment, etc)? __ Yes __No Is a landlord trying to evict from the property? If so, has a Forcible Entry & Detainer Order been obtained by your landlord? When? ___________ __ Yes __ No Other problems? Explain __________________________________________________ __ Yes __ No If married, did your spouse sign any of the company debts?
If so, explain
__________________________________________________________________ There are certain issues that determine whether or not it is appropriate to file now. Check if any apply to your circumstances.
__ Yes __ No Does the company expect to receive a tax refund
for any past year, including the current year? If so, when and
how much.
______________________________________________ If so, when and how much. ______________________________________________ __ Yes __ No Even if the company never expects to collect, does anyone owe it money for any reason whatsoever? If so, when and how much. _______________________________________________ __ Yes __ No Does the company have a right to sue anyone or any entity for anything?
If so, explain
___________________________________________________________ If so, explain ____________________________________________________________ __ Yes __ No Did the company use a credit card to pay taxes within the last year before filing? If so, when and how much. ________________________________________________ __ Yes __ No Does the company owe the IRS and State taxes for employee withholding? __ Yes __ No Does the company owe any sales taxes/transaction privilege taxes? __ Yes __ No Does the company owe any other type of taxes? If so, what type and how much? ____________________________________________ __ Yes __ No Did the company make any charges, balance transfers or take out cash advances of more than $250 put on a credit card or personal loan in the last 3 months?
If so, what card
and for what purchase?
_____________________________________ __ Yes __ No Did the company bounce any checks?
If so, explain ____________________________________________________________
__ Yes __ No Are there any judgments or threatened actions against the company for destruction of property or for injury inflicted? If so, explain: __________________________________________________________ __ Yes __ No Does the company (and you) understand that any debts from obtaining money, property, or services by fraud may survive the bankruptcy?
If there is a problem, explain
________________________________________________________ __ Yes __ No Does the company owe any fines or penalties? (e.g.: court fines, or tickets) If so, describe ________________________________________________________ __ Yes __ No Does the company have any stocks, bonds (including savings bonds) or mutual funds? If so, describe ________________________________________________________ __ Yes __ No Does the company owe any money to any officer, director or shareholder? If so, describe _________________________________________________________ __ Yes __ No Has the
company paid any money or transferred any assets to any
officer, director or shareholder in the last year?
If so, describe
_________________________________________________ HOUSE, LAND AND OTHER REAL PROPERTY INTERESTS
__ Yes __ No Does
the company
own a home or land? First lender: ________________________ Debt owed $ __________ Arrears* $_________ Second lender: ________________________ Debt owed $ __________ Arrears* $_________
Third lender: ________________________
Debt owed $ __________ Arrears* $_________ If so, what is the date and time of foreclosure: _________________________________________ If there is a sale, then provide copies of trustee sale documents and make sure that the trustee's name is listed below as a creditor. It is your responsibility to confirm this date and to keep track of the date at all times; including the entire pendency of your bankruptcy. This office will not monitor the date of sale for you, but we be happy to answer your questions. __ Yes __ No Is this a VA loan (personal liability for VA loan)? __ Yes __ No
Is the company modifying any of the home loans? __ Yes __
No Is there a homeowner's association?
If not, when was a last payment
made?________________ Arrears $_________ __ Yes __ No Did anyone (e.g. officer or shareholder) sign on the loan documents or personal guarantee? If so, who signed and what did they sign: _________________________________________ __ Yes __ No In the last 10 years have any
mortgage payments been made in addition to the regular
monthly payment? If so, describe
____________________________________ __ Yes __ No Does
the company
own a second home or land?
First lender: ________________________ Debt owed $ __________ Arrears* $_________ Second lender: ________________________ Debt owed $ __________ Arrears* $_________ Third lender: ________________________ Debt owed $ __________ Arrears* $_________
*arrears means the
amount the company is behind on the payments. If not, when was a last payment made?_____________________ __ Yes __ No Is there a pending foreclosure or trustee’s sale? If so, what is the date and time of foreclosure: __________________________________________
If there is a
sale, then provide copies of trustee sale documents and make
sure that the trustee's name is listed below as a creditor.
It is your responsibility to confirm this date and to keep
track of the date at all times; including the entire pendency
of the bankruptcy. This office will not monitor it for you.
We will help to answer questions that you may have. __ Yes __ No Is there a homeowner's association on this second property? __ Yes __ No Are the homeowner's association payments current? If not, when was a last payment made?________________ Arrears $_________ If not, is there a lawsuit threatened or filed? _________
__ Yes __ No Does the company own other real estate, (e.g. other house/land, time shares, etc)? Describe: ______________________ Fair market value $_________, Debt owed $ ______ Describe: ______________________ Fair market value $_________, Debt owed $ ______ Describe: ______________________ Fair market value $_________, Debt owed $ ______ __ Yes __ No Are the mortgage payments to the lender(s) current? If not, when was a last payment made?_____________________ __ Yes __ No Is there a pending foreclosure or trustee’s sale? If so, what is the date and time of foreclosure: __________________________________________
If there is a
sale, then provide copies of trustee sale documents and make
sure that the trustee's name is listed below as a creditor.
It is your responsibility to confirm this date and to keep
track of the date at all times; including the entire pendency
of the bankruptcy. This office will not monitor it for you.
We will help to answer questions that you may have.
__ Yes __ No Does the company own other real estate, (e.g. time shares, land, etc)? Describe: ______________________ Fair market value $_________, Debt owed $ ______ Describe: ______________________ Fair market value $_________, Debt owed $ ______
Describe:
______________________ Fair market value $_________, Debt
owed $ ______ If not, when was a last payment made?_____________________ __ Yes __ No Is there a pending foreclosure or trustee’s sale? If so, what is the date and time of foreclosure: __________________________________________
If there is a
sale, then provide copies of trustee sale documents and make
sure that the trustee's name is listed below as a creditor.
It is your responsibility to confirm this date and to keep
track of the date at all times; including the entire pendency
of the bankruptcy. This office will not monitor it for you.
We will help to answer questions that you may have.
__ Yes __ No Does the company
have a storage unit?
VEHICLES AND EQUIPMENT
__ Yes __ No Does the company own any vehicles or equipment? If so, list all. Fair market value: www.kbb.com (private party value) or other third party value. I cannot give you good advice without the fair market value.
Describe:
__________________ Fair market value $______, Debt owed $
________
Describe:
__________________ Fair market value $______, Debt owed $
________
Describe:
__________________ Fair market value $______, Debt owed $
________
Describe:
__________________ Fair market value $______, Debt owed $
________ (no redemption in 13 if purchased in last 2 1/2 years) __ Yes __ No Does the company refinance any of these vehicles after they were originally purchased? __ Yes __ No Did the company finance these vehicles with a credit union? __ Yes __ No Does the company have any leases on anything (cars, equipment, land)?
If so, explain
______________________________________________________________________
INCOME AND TAXES
What is the total amount of the company gross income (before taxes/insurance) two years ago? $________ __ Yes __ No Does the company have any income from rentals? If so, what is the monthly net, after paying mortgage or other liens? $________ __ Yes __
No In the last 8 years has the company
used a third party to prepare financial information (e.g.
tax returns, bank statements, profit & loss, etc)? __ Yes __ No Has the
company filed all required income tax returns, both
federal and state?
If not, what years need to be
filed: ____________________________________________________
If so, explain what type of
debt, year due, when was return filed,
etc._________________________
If so,
explain what type of debt, year due, when was return
filed. ____________________________
If so,
explain the amount due. ____________________________
BUSINESSES __ Yes __ No Does the company own any businesses?
If so describe:
What would a third party pay for the
business: _____________________ __ Yes __ No What
percentage do you own in the company? ______________
THIS DOCUMENT IS INTENDED SOLELY FOR USE OF POTENTIAL CLIENTS OF OUR FIRM. |
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